Nutrition Resources

Wound healing is a complex, multi-phase physiological process that can be compromised by a range of factors, including malnutrition. In community settings, chronic wounds such as pressure ulcers, diabetic foot ulcers, and venous leg ulcers are common and place a significant burden on both patients and the healthcare system. Despite this, nutritional considerations are often overlooked in wound care. This article outlines the critical role of adequate nutrition — particularly protein and key micronutrients — in supporting tissue repair and reducing the risk of chronic wound development. It also explores the impact of malnutrition as both a contributor to wound chronicity and a barrier to healing, with particular attention given to high-risk groups such as older adults and those with diabetes. Practical recommendations are provided to support community nurses in identifying patients at nutritional risk and implementing appropriate dietary interventions or referrals. The importance of a multidisciplinary approach, including timely dietetic input, is emphasised throughout.

Healthy ageing has become a global priority to add quality to our later years and reduce the morbidity associated with ageing. Entering older adulthood, however, increases the risk of frailty and sarcopenia — key factors driving age-related morbidity. Frailty is a multi-system impairment associated with increased vulnerability to stressors. Sarcopenia is the loss of muscle mass and function and is a major component of frailty. Skeletal muscle has a reduced response to stimuli such as protein intake and exercise with advancing age, driving the gradual loss in muscle mass seen in older adults. High protein diets, especially when paired with resistance exercise, can help to overcome this anabolic resistance and restore or maintain physical robustness. The commonly cited protein requirements for adults published by the Department of Health (DH) underestimate the needs of older adults. Other nutritional factors, such as weight loss and vitamin D status, also play important modulating roles in frailty and sarcopenia.

In 2006, the National Institute for Health and Care Excellence (NICE) released the landmark guidance on nutrition, ‘Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ (NICE, 2006). At the heart of NICE guidance and quality standards is the aim to integrate research into practice and reduce gaps between recommended and actual practice. However, successful implementation is dependent on national and local action. To facilitate the implementation of the NICE clinical guidance (CG32), a national multidisciplinary expert panel was convened to explore and develop strategies that would overcome barriers to implementation of the NICE guidance, facilitate access to practical tools, and enhance knowledge to improve the management of disease-related malnutrition in the community. The collaborative work undertaken by the panel, in conjunction with major stakeholders, led to the development of the ‘Managing Adult Malnutrition in the Community’ materials. This article reviews the work of both the initial panel in 2012 and subsequent expert panels, that have delivered and continue to develop resources for nurses and the wider multidisciplinary team to assist in tackling malnutrition, which affects up to three million people in the UK at any time (Elia and Russell, 2009), especially that which arises as a consequence of illness and long-term medical conditions having an impact on appetite and the ability to eat and drink.

The nutritional consequences of Covid-19 are not yet fully understood, but knowledge from acute respiratory distress syndrome (ARDS) suggests that patients are likely to experience skeletal muscle dysfunction, which can persist for weeks to years (Files et al, 2015) and impede return to pre-illness status. Many of the signs and symptoms noted to frequently persist after acute Covid infection, such as breathlessness, fatigue, loss of smell and taste and inflammation, can impact oral intake and potentially worsen nutritional status (Arnold et al, 2020; Carfi et al, 2020; Doykov et al, 2020; Mandal et al, 2020; Sudre et al, 2020).

The term ‘wound’ can cover everything from relatively minor wounds, such as a small surgical scar, to major wounds, such as chronic leg ulcers. Typically, the cause and type of wound determines how quickly and effectively it heals (Thomas and Bishop, 2007). The presence of complications such as infection can dramatically increase the time it takes for a wound to heal. In a 2015 research study, conducted by gathering data from The Health Improvement Network (THIN) database, the cost burden of wound care in the NHS was estimated. After adjusting for comorbidities, the estimated cost to the NHS was between £4.5 billion and £5 billion. Furthermore, the study found that nutritional deficiency and diabetes were independent risk factors for wounds not healing (Guest et al, 2015). Nutritional factors, such as protein-energy malnutrition, dehydration, and deficiency in certain micronutrients, have all been identified as important for some stages in the process of wound healing. Being able to identify those who are malnourished or at risk of becoming so, and those who have micronutrient deficiencies, is key to successful wound healing outcomes.

Claire Campbell, chair of the National Nurses Nutrition Group (NNNG) and nutrition support nurse specialist, Frimley Health NHS Foundation Trust, looks at how community nurses can help to tackle malnutrition and identify those most at risk.

Food fatigue is a psychological condition which results in lack of motivation or enthusiasm to consume food. Left untreated, this can lead to malnutrition, lack of energy and dehydration. In a bid to alleviate food fatigue for customers, including those individuals who may have been clinically shielded or especially vulnerable through the Covid-19 pandemic, home meals delivery company, Wiltshire Farm Foods, has collaborated with leading chefs in the South West and launched a new and inspirational summer kitchen range giving added variety, freshness and choice.

Food fatigue is a psychological condition which results in lack of motivation or enthusiasm to consume food. Left untreated, this can lead to malnutrition, lack of energy and dehydration. In a bid to alleviate food fatigue for customers, including those individuals who may have been clinically shielded or especially vulnerable through the Covid-19 pandemic, home meals delivery company, Wiltshire Farm Foods, has collaborated with leading chefs in the South West and launched a new and inspirational summer kitchen range giving added variety, freshness and choice.

Food fatigue is a psychological condition which results in lack of motivation or enthusiasm to consume food. Left untreated, this can lead to malnutrition, lack of energy and dehydration. In a bid to alleviate food fatigue for customers, including those individuals who may have been clinically shielded or especially vulnerable through the Covid-19 pandemic, home meals delivery company, Wiltshire Farm Foods, has collaborated with leading chefs in the South West and launched a new and inspirational summer kitchen range giving added variety, freshness and choice.

The Managing Adult Malnutrition in the Community team has worked with the British Dietetic Association (BDA) and the British Association for Parenteral and Enteral Nutrition (BAPEN) to develop a range of patient information leaflets to advise those who have Covid-19 illness, or who are recovering after the illness, on eating well to assist in their recovery.